September 25, 2009
Danny Chu, M.D., associate chief of Cardiothoracic Surgery (right) performs surgery with Manish Patel, M.D., a second year thoracic surgery resident (left), and Marc Robinson, a third year Baylor College of Medicine medical student rotating on the cardiothoracic surgery service at the Michael E. DeBakey VA Medical Center. Photo by Shawn James, Media Section
HOUSTON - Patients who undergo coronary artery bypass graft surgery (CABG) at the Michael E. DeBakey VA Medical Center (MEDVAMC) are less likely to die than patients in non-VA hospitals.
In a report in the September issue of the Journal of Surgical Research, researchers from the MEDVAMC, Baylor College of Medicine (BCM), and the University of Houston, found only 1.6 percent of patients who underwent this kind of heart surgery at the DeBakey VA died in the hospital compared to 3 percent at non-VA facilities. The difference is statistically significant, and is compounded with the fact the VA patients were, on average, in poorer health.
“Our analysis showed that CABG patients at the DeBakey VA were generally sicker than non-VA CABG patients, yet their post-surgery in-hospital mortality rate was dramatically lower,” said Danny Chu, M.D., senior author of the paper, associate chief of Cardiothoracic Surgery at the MEDVAMC, and an assistant professor of surgery at BCM. The vast majority of MEDVAMC physicians are also faculty members at BCM.
Using the 2004 Nationwide Inpatient Sample database, the researchers identified 48,669 discharge records of patients who underwent heart bypass surgery in non-VA hospitals and compared them to the records of 688 patients who underwent similar surgery at the MEDVAMC from 2002 to 2006.
While slightly younger, the VA patients had higher rates of prior heart attack, congestive heart failure, peripheral vascular disease, stroke and related ailments, chronic obstructive pulmonary disease, and diabetes.
This past February, the MEDVAMC was recognized for demonstrating consistently low observed-to-expected mortality rates in general surgery, all surgery, and all non-cardiac surgery. It is the only VA to have a statistically low mortality for eight of the last nine years.
“This study is yet another confirmation that our surgical service and anesthesiology staffs provide the very best care to our Veterans,” said David H. Berger, M.D., MEDVAMC Operative Care Line executive. “I am pleased we serve as such a positive example for other hospitals both inside and outside the VA health care system.” Berger is also a professor of surgery at BCM.
During the mid-to-late 1980s, the VA as a whole came under a great deal of public scrutiny over the quality of surgical care. At issue were the operative mortality rates in the VA hospitals and the perception in Congress that these rates were significantly above the private sector norm. To address the gap, Congress passed a law that required the VA to report its surgical outcomes annually and compare them to national averages. The numbers are adjusted for risk and severity of illness.
Others who took part in this research include Faisal G. Bakaeen, M.D. and Joseph Huh, M.D. of the MEDVAMC along with Justin C. Choi, B.S., Scott A. LeMaire, M.D., and Joseph S. Coselli, M.D. of BCM and Tam K. Dao, Ph.D. of the University of Houston.
Funding for this work came from BCM. An abstract of the report is available at http://www.journalofsurgicalresearch.com/article/S0022-4804(09)00162-0/abstract *.
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